420 - The Effects of a Designated Note Writing Hour on Pediatric Intern Note Writing Times and Duty Hours

Poster Number: 420
Publication Number: 420.445

William Adamiak, Cooper Medical School of Rowan University, Paoli, PA, United States; Alla Kushnir, The Children's Regional Hospital at Cooper, Camden, NJ, United States

Background: Interns spend an inordinate amount of the workday writing notes, leading to less time in direct patient care and more duty hour overages. Since the introduction of the 80-hour workweek, it has been shown that interns spend only 12% of the workday in direct patient care, compared to 40% at the computer. A dedicated note-writing hour was introduced in the middle of the pediatric intern shift. This hour allows interns to prioritize their note writing while not amassing a backlog of patients. Within one year of implementation of the designated note-writing hour in July 2019, we aim to establish that 80% of all pediatric intern notes are completed prior to the end of their shift, thus avoiding duty hour overages.

Objective: Within one year of implementation of the designated note-writing hour in July 2019, we aim to establish that 80% of all pediatric intern notes are completed prior to the end of their shift, thus avoiding duty hour overages.

Design/Methods: Data from EPIC electronic health record (EHR) database was reviewed for all notes written by pediatric interns during three periods of interest: prior to the implementation of the designated hour (Jan-May 2019), immediately after implementation (July-Nov 2019), and a year after implementation (May-Aug 2020). Time stamps of when notes were created and when notes were signed were used to calculate the time periods over which notes were written.

Results: Prior to implementation, 67.9% of notes were completed and signed by intern by sign out. In the periods immediately following implementation, and at a year post implementation, completion percentages increased to 72.5% and 73.5% respectively. Prior to implementation, 34.0% of pediatric intern notes were completed by 1415 hours (end of the dedicated note-writing hour). In the post implementation period, percentage of notes completed by 1415 increased to 49.5% and 53.7% respectively, demonstrating an immediate 45.6% change and a 57.9% change at 1 year.Conclusion(s): The introduction of a designated note-writing hour for pediatric interns led to an increase in the percentage of notes completed by end of shift, though missing the 80% target. One limitation of this study is the variation in sample sizes of total notes analyzed across the three time periods. Further research is needed to find methods to improve intern note writing habits and minimize duty hour violations.
Percentage of Notes Completed by Pediatric Interns Before and After Implementation of Designated Note Writing Hour
Graphical Representation of Pediatric Intern Note Writing Completion